Provider Demographics
NPI:1972908960
Name:YULI FRADKIN MD LLC
Entity Type:Organization
Organization Name:YULI FRADKIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YULI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRADKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-685-9836
Mailing Address - Street 1:39 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2913
Mailing Address - Country:US
Mailing Address - Phone:646-685-9836
Mailing Address - Fax:
Practice Address - Street 1:94 VALLEY RD FL 2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2211
Practice Address - Country:US
Practice Address - Phone:646-685-9836
Practice Address - Fax:888-512-2123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA092830002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty